Studies have suggested that adults with chronic disease are often unable to meet medication and food needs. “Physicians sometimes recommend or prescribe medications to patients with chronic diseases without considering the costs of these therapies,” says Seth A. Berkowitz, MD. Few studies have explored the relationship between cost-related medication underuse and food insecurity. A Closer Look In a study published in the American Journal of Medicine, Dr. Berkowitz and colleagues examined data from nearly 9,700 adults with chronic illness, looking specifically at groups that most commonly face unmet food and medication needs. About 23% of study participants reported cost-related medication underuse, nearly 19% reported food insecurity, and 11% reported having both of these problems. “Our findings demonstrate that these problems are common,” says Dr. Berkowitz. “One in three chronically ill adults will have trouble affording food, medication, or both.” Adults who reported food insecurity were significantly more likely to indicate that they underused their medications due to costs. Some participants reported skipping their medications entirely so that they could afford to eat. Hispanics and African Americans were more likely than other groups involved in the study to report cost-related medication underuse and food insecurity. People with numerous chronic health problems and those without health insurance were also more likely to report difficulty affording medicine and food. Those receiving Medicaid and those participating in the Special Supplemental Nutrition Assistance Program for Woman, Infants, and Children were less likely to report such difficulties. Many of the study participants who had trouble affording food and medications had incomes that were 100% to 200% above the federal poverty line. It is possible that...

About 10 years ago, researchers validated the BODE index—which stands for BMI, airflow obstruction, dyspnea, and exercise capacity—as a prognostic mortality risk tool for patients with COPD (Table 1). “The development and validation of the BODE index was an effort to more fully characterize disease severity in patients with COPD,” explains Melissa H. Roberts, MS, PhD. “It captures not only the clinical measurements of COPD through a lung function test, but also some of the systemic effects of the disease that can appear in patients with COPD.” Since 2004, many studies have demonstrated that the BODE index is a more accurate predictor of mortality among patients with COPD than lung function alone. Additional analyses have shown that the index can also serve as a good predictor of severe COPD exacerbations resulting in hospitalization. Over this same stretch of time, other studies have assessed modified versions of the BODE index to determine if other measurements may offer additional value, but these analyses have had mixed results. A Simpler Approach Although the BODE index has proven to be useful, research has suggested that implementing use of the tool can be challenging, oftentimes proving to be impractical if patients are debilitated. Recently, Dr. Roberts and colleagues examined a simplified, quasi-BODE index and published their results in the American Journal of Epidemiology. “The spirometry test for measuring FEV1 to determine airway obstruction and the 6-minute walk test for measuring exercise capacity are not always easy to obtain, especially in patients who are not ambulatory,” explains Dr. Roberts. “A substantial percentage of patients are unable to complete either or both of these tests. In...

It was with great sadness that we all saw the tragic news of Robin Williams’ suicide. For years, mental health has been a taboo topic. While the passing of this great actor is horrifying, we are only aware of it because of his stardom. How many others have met a tragic fate like his, but we just do not hear about it because they are ordinary people? It affects all ages, all races, and socioeconomic statuses. It is not a phenomena located to the U.S. but all across the globe. True that many people have trouble gaining access to mental healthcare sources, often for insurance coverage reasons or lack of available providers. But more often, help isn’t pursued because of the stigma attached to mental health diagnoses. All too often patients are embarrassed to admit they have a mental health problem. Yet, diseases such as anxiety and depression are very prevalent in our society. These conditions are chronic medical problems, just like diabetes and hypertension. But patients are often made to feel that these diseases are just in their head and that they can just “get over it.” This does not just happen in our general society, but when they seek medical help as well. Patients do not understand that even physical pain can be an underlying sign of depression. And many feel that their healthcare providers brush it off as “just depression.” So, rather than face these stigmas and embarrassments, many choose to deny or hide their illnesses. They are left untreated, which allows tragedies like suicide to occur. How can mental healthcare stigmas be ended? 1. More...

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